Supporting successful breastfeeding using the NIDCAP Model of Care

Susan Vaughan RGN/RM CNS NIDCAP trainer in training. Report By Sue Jameson

For those of you who do not work in a hospital setting or in a NICU I will start with the definition of NIDCAP. NIDCAP is the Newborn Individualised Development Care and Assessment programme. 

NIDCAP is based on the knowledge of the maturation of the brain and the Synactic Theory of Development. Prof Heidelise Als in Boston Children’s Hospital noted differences in the responses of babies to different care givers. Some care givers were more able to tune in to the needs of their tiny patients.

Susan’s passion is the delivery of this integrated care, in order to ensure the best outcomes for the tiny babies 23 weeks and onwards, and their families. She is the first NIDCAP professional in Ireland and she is currently training to be a NIDCAP trainer. 

As someone with a huge interest in Developmental Psychology this session really touched all the right notes for me. It was compelling and exciting to see what can be achieved with premature infants using individualised care and parent involvement. The approach is sensitive to individual baby and their differences. Caregivers are encouraged to observe what destabilizes their baby’s autonomic system and support them to re-stabilize.

Sensory integration - the process by which the brain organises sensory information for appropriate use - occurs in the womb from the early weeks of gestation. How this ties into the growth and behaviour of the neonate is an important starting point.

Neonate sensory development emerges in a specific sequence in utero, avoiding competing with each other:

• Touch : 7 weeks
• Taste & Smell: 16 weeks
• Hearing: 24 weeks
• Suck: 32 weeks
• Vision: 28-32 weeks

Every touch, movement and emotion is translated into electrical and chemical activity that effects the neural circuits and the way the brain is wired. The senses are activated, with touch being the predominant one.

Babies learn to respond to touch so when an unpleasant stimulus such as a repeated heel prick occurs, the baby will pull their leg away. The opposite is also true. Positive touch will calm a baby. With smell – baby turns to mothers smell or turns away from an unpleasant smell such as hand gel.

With hearing the baby will startle from noise, and light will cause baby’s eyes to close and avoid bright lights. 

If the brain is not processing or organising the input of sensory information then learning becomes difficult and baby cannot cope with ordinary demands of life and stress. 

So what might the baby be telling us when they exhibit stress signals – diffuse states, eyes closed, panicky, or worried?  Possibly slow down and look at me. 

Overstimulation can be as stressful as painful events. 

So how can the caregivers help the little babies to have a more positive experience in their early weeks? We need to focus on observing how the neonate reacts to the world as they experience it. 

We learn their feeding cues and readiness to feed in order to make feeding a positive experience. This helps to establish feeding quicker and engages parents fully with their small person.

We can also judge if the sensory experience is appropriate by observing their muscle tone and movement, so we can give them the support they need.

An interesting fact is that babies at different gestations are capable of different things. Sadly, the late preterms are often the forgotten babies – the great pretenders as one of our colleagues calls them. The worst thing you can be as a late preterm is to be a good weight as these babies will get home without the follow up that the smaller babies have. However, they still have a lot of brain development to do and they may be very disorganised, difficult to rouse and poor feeders. In my personal opinion these babies miss an opportunity for the level of care that a baby born only a week or so earlier will have access to throughout early childhood.

So what can staff do to help?

We need to support and encourage parents. Our role is also to translate the baby cues for parents, to build their confidence in reading their own baby, we can set the scene and provide opportunities for positive interactions with their baby. Teaching parents to watch the baby for cues as to their baby’s state is one of the best tools they can acquire.

Continuing to be mindful of parental feelings  is another key component to care – the emotional rollercoaster of a neo parent can not be underestimated. They may be experiencing guilt, fear, inadequacy, exhaustion, bonding difficulties, and depression.

So how does breastfeeding fit with the early preterm baby? Colostrum can be used for pain relief, mouth care and to soothe baby. Many stimuli that the baby is exposed to are noxious, particularly smells, or tubes all round their faces, suction tubes, and other unpleasant physical experiences. Take for example the smell of alcohol hand gel –  one piece of research shows that  babies oxygen levels fall when exposed to the smell.  Using mother’s breast milk and colostrum for all procedures can help with the re-stabilizing of the neonate, as can simple things like lower light levels, gentle touch and the gold standard of skin to skin contact and kangaroo care whenever possible.  The abundance of research  supports kangaroo care and it is the most positive touch experience for neonates. Also, babies are more stable, and milk supply improves with skin to skin –  which also creates a protective microbiome for baby. Sadly, we can disempower parents very quickly by over assessing production of milk and failing to value the tiniest drop of colostrum expressed. An appropriate response might be ‘great job, you’re really getting the hang of this’. 

Susan really highlighted how important communication skills are when working with parents in the NICU. Her closing sentence said it all – ‘we have such power in the neo – we can build them up or we can knock them down. It’s so important how we interact with people and every contact counts’.

Thank you Susan for an inspiring talk and excellent Q & A session after your presentation.

Complied by: Sue Jameson, IBCLC

Sue did receive a bursary from ALCI for this report. ALCI Council would like to thank Sue for her report.

Dated: 25th October 2024. 

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